Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial

Cao, Zhang; He, Jiangqin; Shi, Qinye; Bao, Feichao; Xu, Jianhong

doi:10.1186/s12871-022-01662-0

Cited by 28 publications

(16 citation statements)

References 17 publications

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“…The consumption of propofol during the period of LOC and BIS ≤60 showed a trend toward lower values in group ESK-12 and group ESK-20, but the differences did not reach statistical significance ( p > 0.05). The combined use of esketamine with propofol had no effect on the duration of anesthesia, did not reduce the total consumption of anesthetic drugs and vasoactive drugs, and had no effect on vital signs, which was inconsistent with previous studies in children ( Zheng et al, 2022 ) and adults ( Zhang et al, 2022 ). The interpretation may be that the doses we used were small, and different drugs such as midazolam were used in the other study ( Zhang et al, 2022 ).…”

Section: Discussioncontrasting

confidence: 82%

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

XiaoTang²,

Zhang³

et al. 2022

Front. Pharmacol.

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Background: Propofol is widely used during anesthesia. However, propofol-induced injection pain (PIP) is considered an unpleasant perioperative outcome. This study aimed to investigate the efficacy of a mixture of esketamine and propofol in preventing propofol injection pain in patients undergoing general anesthesia.Methods: This was a prospective, double-blind, multicenter, and randomized controlled trial. We included 252 adult patients with the American Society of Anesthesiologists physical status I to II who underwent surgery under general anesthesia. Patients were randomly allocated in a 1:1:1:1 ratio to four groups (n = 63 per group). Group NS received a mixture of 1% propofol (20 ml) and 0.9% normal saline (1 ml), group ESK-4 received a mixture of 1% propofol (20 ml) and esketamine 4 mg (diluted with 0.9% normal saline, 1 ml), group ESK-12 received a mixture of 1% propofol (20 ml) and esketamine 12 mg (diluted with 0.9% normal saline, 1 ml), and group ESK-20 received a mixture of 1% propofol (20 ml) and esketamine 20 mg (diluted with 0.9% normal saline, 1 ml) as sedative drugs during anesthesia. The primary outcome was the incidence and distribution of different degrees of PIP. The secondary outcomes were vital signs, characteristics of surgery and anesthesia, and adverse events.Results: The incidence of PIP in group ESK-20 (33.3%) was significantly lower than that in groups NS, ESK-4, and ESK-12 (63.3%, 62.2%, and 49.1%, respectively; p < 0.01). The incidence of moderate PIP in group NS (33.3%) and group ESK-4 (22.6%) was higher than that in groups ESK-12 (7.5%) and ESK-20 (6.7%). The incidence of severe PIP in group NS (6.7%) and group ESK-4 (9.4%) was higher than that in groups ESK-12 (1.9%) and ESK-20 (0%). There were no differences in the vital signs, characteristics of surgery and anesthesia, or adverse events between the groups.Conclusion: Our results indicated that the esketamine–propofol admixture reduced the incidence of PIP in patients undergoing general anesthesia without severe side effects.

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Section: Discussioncontrasting

confidence: 82%

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

XiaoTang²,

Zhang³

et al. 2022

Front. Pharmacol.

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“…Esketamine possesses a higher efficiency and mainly acts on N-methyl-D-aspartate (NMDA) receptor and integrates sedation, analgesia, and the anesthesia effect ( Smits et al, 2017 ; Van de Bunt et al, 2017 ; Kalmoe et al, 2020 ; Harder et al, 2022 ; Li et al, 2022 ). Its analgesic effect is twice that of ketamine; therefore, lower clinical doses of esketamine are demanded, and side effects (such as nightmare, delirium, and agitation) are decreased ( Zhang et al, 2022 ). It has been adopted in some European countries for decades and has been used in Chinese hospitals in recent years.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

Zheng

Sang

et al. 2022

Front. Pharmacol.

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Background and Purpose: Data and high-quality studies of anesthetic methods for children with obstructive sleep apnea hypopnea syndrome (OSAHS) who undergo drug-induced sleep endoscopy (DISE) are limited. Research on pediatric DISE using esketamine has never been reported before. To test the safety and efficacy of esketamine during DISE in children with OSAHS, we compare esketamine (Group K) with dexmedetomidine (Group D) in this study.Methods: 100 children with ASA Ⅰ∼Ⅱ grade, prepared for an elective adenotonsillectomy under general anesthesia, were enrolled in this study and randomized into two groups. Midazolam 0.1 mg/kg was administered intravenously for both groups. In Group D a 1 μg/kg bolus of dexmedetomidine was given over 10 min followed by the infusion rate 1 μg/kg/hr to the end of DISE. Group K received a 1.0 mg/kg IV bolus of esketamine over 10 s followed by the infusion rate 1 mg/kg/hr to the end of DISE.Results: Group K had a higher percentage of success than Group D (p = 0.008). The onset time of Group K was shorter than that of Group D (p = 0.000). The University of Michigan Sedation Scale (UMSS) score of Group K was higher than that of Group D (p = 0.005). The risk of adverse effects (AEs) was lower in Group K (p = 0.000). In Group D, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) all decreased, while in Group K, SBP, DBP, and HR hardly changed.Conclusion: Esketamine in comparison to dexmedetomidine provides more effective and safer depth of anesthesia for OSAHS pediatric DISE by ensuring short onset time, deep sedation, and few AEs.Clinical Trial Registration: ClincalTrials.gov, identifier NCT04877639

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“…The subanaesthetic dosage of ketamine (no more than 0.35 mg/kg or 1 mg/kg/h) can improve postoperative pain and reduce the consumption of opioids by 20%. It is also widely used in painless gastroscopy as an analgesic (14).…”

Section: Introductionmentioning

confidence: 99%

“…It has been adopted in some European countries for decades and has been used in Chinese hospitals in recent years. Its analgesic effect is twice that of ketamine; therefore, lower clinical doses of esketamine are demanded, and side effects (such as nightmare, delirium, and agitation) are decreased (14). In theory, esketamine is suitable for the analgesia and sedation needs of percutaneous liver tumor ablation (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

The use of Esketamine in CT-guided percutaneous liver tumor ablation reduces the consumption of remifentanil: a randomized, controlled, double-blind trial

Su¹,

Zhang²,

Wang³

et al. 2022

Ann Transl Med

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Background: In the anesthesia management of percutaneous liver tumor ablation, the requirement of analgesia is very strict. Currently, intravenous anesthesia is commonly used, such as remifentanil combined with sedative drugs. However, the pain relief is not instantaneous after increasing the dosage of remifentanil.Esketamine, a medium-or long-term analgesic drug, does not inhibit respiration to maintain patient comfort during the ablation and reduces the consumption of remifentanil. Therefore, this experiment was designed to investigate the potential of combinational therapy and the most appropriate dose of esketamine.Methods: A total of 120 patients were randomly divided into three groups by SPSS. The regular anesthesia model included dexmedetomidine 0.5 μg/kg, intravenous glucose tolerance test, remifentanil continuous infusion, flurbiprofen 50 mg, i.v., palonosetron 0.225 mg, i.v., and 1% lidocaine for local anesthesia. Group A was the regular control group, only using the regular model; Group B also received with 0.1 mg/kg esketamine, i.v.; and Group C also received 0.2 mg/kg esketamine, i.v.. The whole experiment was doubleblind.

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Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial

Cited by 28 publications

References 17 publications

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

The use of Esketamine in CT-guided percutaneous liver tumor ablation reduces the consumption of remifentanil: a randomized, controlled, double-blind trial

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